What physical examinations are observed during an in-person GP consultation? Automatic extraction using a text-based approach

Objectives: Teleconsultation is anticipated to have a long-term role in primary care. However, conducting virtual physical examinations is a well-known limitation. To anticipate unmet needs general practitioners (GPs) and patients may experience during teleconsultation, this study aims to automatically identify physical examinations typically conducted during in-person GP consultation. Material and Methods: This study utilizes 281 GP in-person consultations (de-identified transcripts & video recordings) within UK general practices, where 169 eligible ones were included in this study. We propose an automated text-based approach using regular expressions on keywords in GP-patient consultation dialogue (e.g., “roll up your sleeves”) to identify physical examinations (e.g. blood pressure measurement). This approach involves the construction of conceptual diagrams to visually inspect the relationship between keywords and physical examinations, syntax analysis to identify patterns between keywords and generate regular expressions, and the use of these regular expressions in consultation transcripts to detect potential instances of physical examinations, where matching video frames were subsequently retrieved. The performance of our automated text-based approach is compared to manual classification by 2 independent researchers using 5-fold cross-validation (precision, recall, and F1-score). Results: Among the 169 eligible GP in-person consultations, 133 (79%) required a physical examination, while the other 33 visits were for psychological reasons. Out of these 133 consultations, a total of 283 physical examinations were observed, with 21 instances conducted behind a curtain. We identified 42 distinct types of physical examinations from these 283 instances, grouped into 10 physical examination categories based on body areas and physical artefacts. The most frequent category of physical examinations is Vital Signs 26.80% (76/283). Overall, blood pressure measurement (also belonging to the Vital Signs category) is the most frequent physical examination at 59.2% (45/76). The comparison between manual classification and the regular expression model demonstrates an average precision of 88.3%, recall of 78.9%, and an F1-score of 83.3% from 5-fold cross-validation, providing significant insights into the frequency and types of physical examinations conducted during in-person GP consultations. Conclusion: By using regular expressions in consultation dialogues between GPs and patients, we can automatically identify physical examinations in GP consultations with a precision of 88.3%. Findings from this study, i.e. physical examinations during in-person GP consultations, provide insights into areas where GPs and patients may need support during teleconsultation.